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Healthy Eating Website Promoted Using Social Marketing Principles. a Case Study International Journal of Environmental Research and Public Health Article Process Evaluation of the ‘No Money No Time’ Healthy Eating Website Promoted Using Social Marketing Principles. A Case Study Lee M. Ashton 1,2,* , Megan E. Rollo 1 , Marc Adam 3 , Tracy Burrows 1 , Vanessa A. Shrewsbury 1 and Clare E. Collins 1 1 School of Health Sciences, College of Health, Medicine and Wellbeing, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; [email protected] (M.E.R.); [email protected] (T.B.); [email protected] (V.A.S.); [email protected] (C.E.C.) 2 School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia 3 School of Electrical Engineering and Computing, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW 2308, Australia; [email protected] * Correspondence: [email protected]; Tel.: +61-(2)-4913-8034 Abstract: Background: Reaching and engaging individuals, especially young adults, in web-based prevention programs is challenging. ‘No Money No Time’ (NMNT) is a purpose built, healthy eating website with content and a social marketing strategy designed to reach and engage a young adult (18–34 year olds) target group. The aim of the current study was to conduct a process evaluation of the 12-month social marketing strategy to acquire and engage NMNT users, particularly young adults. Citation: Ashton, L.M.; Rollo, M.E.; Methods: a process evaluation framework for complex interventions was applied to investigate the Adam, M.; Burrows, T.; Shrewsbury, implementation of the social marketing strategy component, mechanisms of impact and contextual V.A.; Collins, C.E. Process Evaluation factors. Google Analytics data for the first 12 months of operation (17 July 2019 to 17 July 2020) was of the ‘No Money No Time’ Healthy evaluated. Results: in year one, 42,413 users from 150+ countries accessed NMNT, with 47.6% aged Eating Website Promoted Using Social Marketing Principles. A Case 18–34 years. The most successful channel for acquiring total users, young adults and return users Study. Int. J. Environ. Res. Public was via organic search, demonstrating success of our marketing strategies that included a Search Health 2021, 18, 3589. https:// Engine Optimisation audit, a content strategy, a backlink strategy and regular promotional activities. doi.org/10.3390/ijerph18073589 For engagement, there was a mean of 4.46 pages viewed per session and mean session duration of 3 min, 35 s. Users clicked a ‘call-to-action’ button to commence the embedded diet quality tool in Academic Editor: Paul Tchounwou 25.1% of sessions. The most common device used to access NMNT (63.9%) was smartphone/mobile. Engagement with ‘quick, cheap and healthy recipes’ had the highest page views. Conclusions: Received: 11 March 2021 findings can inform online nutrition programs, particularly for young adults, and can apply to other Accepted: 26 March 2021 digital health programs. Published: 30 March 2021 Keywords: google analytics; process evaluation; healthy eating; website; young adults; social Publisher’s Note: MDPI stays neutral marketing with regard to jurisdictional claims in published maps and institutional affil- iations. 1. Introduction Globally, poor diet quality is the second highest risk factor for mortality in females, resulting in 13.5% [10.8–16.7] of all female deaths in 2019 [1]. For males, it is the third Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. leading risk factor, accounting for 14.6% [12.0–17.6] of all male deaths in 2019 [1]. Optimal This article is an open access article diet quality is key to good health, well-being and the prevention of chronic conditions distributed under the terms and including; cardiovascular disease (CVD), type 2 diabetes, and specific cancers [2,3]. How- conditions of the Creative Commons ever, improving diet quality represents a major public health challenge at both a national Attribution (CC BY) license (https:// and international level [1]. This is particularly challenging among young adults. A global creativecommons.org/licenses/by/ analysis of adults aged ≥20 years from 187 countries found those aged 20–29 years had 4.0/). the worst diet quality, compared with all other age groups, closely followed by those in Int. J. Environ. Res. Public Health 2021, 18, 3589. https://doi.org/10.3390/ijerph18073589 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 3589 2 of 19 the 30–39 year age group [4]. Furthermore, key transitional changes are common during this life stage including changes to employment status (e.g., starting College/University), living situation (e.g., moving away from parents), social environment and influences (e.g., changes to peers and partner relationships), and financial position (e.g., becoming more self-sufficient) which can impact on lifestyle behaviors [5]. Many behavioural interventions have demonstrated efficacy in improving dietary intake but few report ‘real world’ effectiveness data or demonstrate impact over time and across contexts [6,7]. According to one review, it takes an average of 17 years to move 14% of research into clinical practice [8]. As such, a large proportion of health research fails to move beyond pilot studies and small-scale trials to provide ongoing benefits at a population level [9]. A collective challenge in preventive health is reaching and engaging individuals, especially young adults who are deemed ‘hard-to-reach’ due to their perceptions that health problems are distal [10]. Failure to recruit sufficient numbers can lead to false negative findings and can impact representativeness of population samples [11]. Online programs have the potential to overcome these barriers, with opportunities to improve reach, accessibility, scalability and achieving cost-effectiveness [12,13]. However, they are commonly reported to have limited ability to engage and retain participants [14]. A review of engagement among 21 online dietary interventions identified low to moderate rates of attrition for those reporting significant positive changes in diet [14]. Therefore, greater understanding of how to reach and engage individuals over sustained periods in a ‘real world’ context is necessary to achieve long-term improvements in diet and have an impact on individual and population health. The methods section of this paper describes the development and implementation of a world first purpose built healthy eating website ‘No Money No Time’ (NMNT) http://nmnt.com.au (accessed on 1 February 2021), that factors in time and financial constraints, to improve dietary quality, reduce chronic risk and improve overall health and wellbeing. While the website is freely accessible to all users of the internet, it was developed for a target group—young adults aged 18–34 years. In order to maximise the reach of NMNT and all/target users’ engagement with the website, and to inform the development of future websites with similar aims, in the method section of this paper we describe in detail the process of developing and applying social marketing principles to maximise user reach and engagement with NMNT, particularly users 18–34 years. Social marketing looks to promote public health by applying commercial marketing strategies and has potential to make an impact at the population level [15]. The consensus definition for social marketing is that it: “seeks to develop and integrate marketing concepts with other approaches to influence behaviours that benefit individuals and communities for the greater social good [16].” A helpful guideline to determine the extent of social marketing within a program/intervention has been proposed by Andreasen (2002) [17]. Andreasen’s six benchmark criteria are; behavioural objective, audience segmentation, formative research, exchange, marketing mix and competition. Findings from a recent review of 34 social marketing interventions to improve dietary patterns recommend that application of all six benchmark criteria has greatest potential to improve eating patterns [18]. In complex real world interventions such as NMNT, embedded process evaluation is a key step to identify improvements that can be made before proceeding to impact and outcome evaluation. During the design of NMNT we did not identify any relevant publications that had presented detailed results of the process evaluation of social mar- keting strategies, implemented to maximise reach and engagement of young adults, in the context of a nutrition website intervention. While the results from the current study have already been used to further improve the NMNT marketing strategies and website, by publishing the methodology, of the approach, results are likely to be useful in guiding other researchers or public health clinicians in conducting similar evaluations. Therefore, the aim of the current study was to conduct a process evaluation of a 12 month social marketing strategy to acquire and engage NMNT users, particularly the Int. J. Environ. Res. Public Health 2021, 18, x 3 of 19 Int. J. Environ. Res. Public Health 2021, 18, 3589 3 of 19 Therefore, the aim of the current study was to conduct a process evaluation of a 12 month social marketing strategy to acquire and engage NMNT users, particularly the tar- target group of young adults. The evaluation was guided by the UK Medical Research
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